Hearing aids and their importance. Mahendra Gonsalkorale

Hearing aids and their importance

Mahendra Gonsalkorale

This is an important topic that Srianee brought to our notice.  I wrote a new article that included the relevant material from her comment on the subject in the previous post.

The topic relates to these main areas.

1)   The importance of detecting hearing loss early.

2)  The cosmetic aspects of wearing hearing aids and how they relate to our concept of identity (how we wish to be seen and regarded).

3)   The good fortune to live at a time when there are excellent options to make hearing loss no longer a handicap.

4)   The rewards of persistence when faced with early problems but continuing to wear them.

On the first point, as Srianee has indicated, there is good evidence that if remedial aids are not worn, the hearing loss will continue with evidence of irreversible changes in the auditory cortex. (like turning the water flow (auditory stimulation) to feed a plant from a stream to a trickle). If aids are worn, this process is slowed down. The auditory loss has profound consequences for maintaining our intellect also as if uncorrected, the brain loses the advantages of communicating with others, keeping up to date with information and losing the rewards that auditory stimuli can provide. 

The take-home lessons are:-

Expect hearing loss as we age – especially after 70 yr. (Over half the population aged 55 or more have hearing loss. 80% of people over 70 will have hearing loss). These hearing loss population estimates are calculated using the most robust data available on the prevalence of hearing loss (average hearing levels of 20dB or worse in one or both ears) for adults aged 18 to 80, combined with population estimates from the Office for National Statistics (ONS). Source RNID (Royal National Institute for Deaf People).

Get your hearing tested by a competent audiologist. The services vary in different countries, but a simple hearing assessment won’t break your purse or threaten you with penury!

Choose from the wide range available as we all have different perceptions of what is suitable (cosmetic, comfort, power: disposable batteries or rechargeable) etc. Digital ones are by far the best and you can choose from a wide range from behind the ear, in-ear, hardly visible etc. Most providers give a 3-month trial period free of charge with no commitment to buy as they know from experience that the vast majority, although initially shocked at the cost, decide to keep them as the rewards are so great.

I would advise wearers to wear them all the time except when showering, bathing, etc and take them off at night.

At first, it may be slightly uncomfortable, but if you persist, you don’t even notice that you are wearing them.

I have worn different types for 20 years! Initially, I was very self-conscious and did not want others to know that I wore aids. It was as I realised with wisdom, a wrong belief which could only harm me.  I soon appreciated that it made a huge difference in my life, and I have no reservations about recommending them. Like Srianee, I would go for rechargeable batteries. If you feel self-conscious, this is natural, but very soon, you realise that to be seen wearing hearing aids is not a stain on your character. It does not reduce the esteem people have for you. I always announce to new people that I wear hearing aids as even with the best aids, your hearing cannot match normal hearing. People then appreciate that you are not stupid when they talk to you and become much more understanding and often modify the way they speak by more deliberate pronunciation and the use of visual cues. You must be prepared to meet the odd person who will shout at you and talk to you as if you are an imbecile, but these ignorant people are, fortunately, rare. You will be surprised how much visual cues play a role in communicating. Watching is as important as hearing, that's why people with impaired hearing often are worse when the lighting is poor.

I wear black in-ear aids as I found the behind the ear ones with a small pipe ending in an almost invisible ear plug (earphone) uncomfortable and messy to manage. I made the decision after trying both, and furthermore, rechargeable batteries were available only for the in-ear ones. I feel no shame in wearing them (like wearing specs if you have problems with sight), and it is understandable that some don’t like to wear them as they feel that they convey a wrong impression; that of an ageing, decrepit old person! (although even if so, being old and decrepit is not something to be ashamed of at all. (Being conceited, selfish, and lacking in empathy or patience are the bad ones! ).

I hope you find this useful. Please contact me directly or via the blog if you need more clarification or information.

Here are the comments in Srianee’s  Embracing Technology post.

Srianee

I would like to take a little detour now and write about another technical innovation that has improved my life. My hearing aids (plural). A few years ago my family (my daughters in particular) were complaining that I was making them repeat what they were saying. “Mom, you need to get your hearing checked!” My response was, “Oh you people mumble” or “You talk to me while walking away from me.” I’m sure that sounds very familiar to many of you. I finally relented and got my hearing checked out. The verdict was “mild hearing loss” and I was given the option of trying out a pair of hearing aids for 3 months. I was told that I could return them if I felt that they didn’t improve my hearing. I tried them out and I was converted! I certainly didn’t want to return them. 

I am now an ardent advocate for the use of hearing aids before the hearing loss becomes too severe. Unfortunately, hearing aids are expensive and not very user-friendly. But, It is easier to get accustomed to using them when you are seventy than when you are ninety. I would recommend getting the rechargeable types, because fiddling with the tiny batteries is not an easy task.

Most new hearing aids can be adjusted using the bluetooth function on a smart phone. Of course, the two devices need to be ‘paired.’ (The people who supplied the hearing aids did that for me.) 

I know that many people don’t want to wear them all the time. Why? If it is not part of your routine like brushing your teeth, you will forget to wear them daily. On most days I don’t have anyone else in my home conversing with me, but yet I wear my hearing aids, because every sound I hear, the chirping of the birds outside my window or the music I am listening to, is sending stimulating signals to my brain, and that is a very good thing.

 There is growing evidence that if hearing loss is not corrected in time, cognitive loss will occur. This is a very important reason for getting one’s hearing checked. If hearing aids are recommended, make the effort to learn how to use them effectively. Once you master the finer points, you will experience many wonderful things that you never knew you were missing!

Nihal

Thank you Srianee for bringing up an important topic. Hearing is vital for our well being at any age. At our age it is essential to maintain contact with friends and family and to keep our minds in gear.

Hearing aid seem like an important accessory for old age and a very useful one too. I listen to a lot of classical music often at great cost to myself, at the concert halls in London. When I found that I couldn’t hear the high notes of the violins I thought my hearing wasn’t good enough and got my hearing tested. The person who tested me was a pretty Afrikaans lady. Her accent was hard to decipher and I wasn’t sure if it was my hearing or her accent that was the problem. Anyhow we struggled through the test. I went for a basic behind the ear hearing aid (BTE) which changed my hearing and my life for the better.

There are a few issues with the contraption. At my age I do not mind its bulk and ‘unsightly’ appearance. There are occasional extraneous noises like squeaks specially while in a crowded noisy room. I have learnt to ignore them. It is a hindrance than a help speaking in a room with a large gathering. I remove them and manage ok.

The hearing aid is a foreign body hanging on to my ear. After a couple of hours it gets tiresome and I remove them. I tend to wear them every day but in short bursts when I’m listening to music. This seems like a good compromise.

My hearing aid requires batteries and I cope quite well changing them weekly.

Srianee

Nihal, thank you for sharing your experience with your hearing aids. The current designs with the microphones tucked behind the ear is not the most efficient. But, if there is a visible contraption in front of the ear, people will be even more reluctant to wear them. I saw something on TV recently, where the hearing aids are incorporated into spectacle frames. The microphones are in the front of the frames, and the sound is transmitted to the receivers that go into your ear invisibly through the spectacle frames. I'm not sure if such hearing aids are commercially available. The biggest hurdle for most people is the cost.

Ask the Expert- Challenges and Opportunities in an Ageing Society Mahendra Gonsalkorale

Challenges and  Opportunities in an Ageing Society

Mahendra "Speedy" Gonsalkorale

I like to reproduce my Reunion Presentation in Sept 2012 as it is even more relevant now. There is a short update addendum at the end.

This is a summary of the Lecture delivered by Dr Mahendra Gonsalkorale at the 50th Anniversary Reunion Academic session of the Medical Entrants of 1962 in Sri Lanka on September 1, 2012.

The World population is growing rapidly. From an estimated 2.5 billion in 1950, it reached 6.1 billion in 2000 and is projected to grow to 8.2 billion in 2025. It took over 4000 years to reach 2 billion but it will take less than 75 years to quadruple that number. Sri Lanka’s current population of just over 20 million will grow to 23 million by 2030. People are also surviving longer at all ages and increasingly achieving old age. Increased life expectancy is a Global phenomenon. Correspondingly, due to the decrease in fertility rates, there is less than the expected numbers of younger people, and the net result is a change in the age distribution pyramid from the familiar broad-based, gradually tapering shape as in the mid 60s and before, to one with a relatively narrower base with a “fat” middle (the older people) and a taller shape (because of the persistence of the very old).
 

 

 The proportion of elderly people in all countries is increasing. From about 4-10% just 50 years ago to 15-20% now and expected to increase to 25-30% in the mid 2000s. In Sri lanka, there are about 1.9 million over the age of 60 (10%) and this is expected to increase to 4.5 million (25%) by 2040. There are currently around 40 million over 65s in America compared to 23M just 50 years ago. Within the over 60s, there is a massive increase in the very old. The balance between the older and younger is affected and this will significantly affect the care of older people and the financing of pensions.

1 More old people and less (proportionately) young people means

2 More age-associated diseases such as dementia (Alzheimer’s), cardiovascular diseases, degenerative neurological disorders, cancer, arthritis and related disorders, chronic respiratory disease, and other chronic diseases.

3 Increase in disability levels in the population

4 Less people to support and care for older people.

5 Large increases in health and social care costs. 

The burden of Dementia is one of the most worrying concerns for the future. The WHO estimates that worldwide, nearly 35.6 million people live with dementia. This is expected to double by 2030 (65.7 million) and more than triple by 2050 (115.4 million). The vast majority of these will be elderly.

Dementia affects people in all countries, with more than half (58%) living in low- and middle-income countries. By 2050, this is likely to rise to more than 70%. The WHO observes that only eight countries worldwide currently have national programmes in place to address dementia.  

This may all sound very negative, but there is a more optimistic view to be taken, and with greater preparation and anticipation of need, the lives of both the elderly and the young could be enhanced. Older people can have a better quality of life, and the young can look forward to a time of fulfilment and relative leisure when they become old. 

Some of the challenges that need to be met are the following. 

(1)  Meeting health, social and housing needs. These are also fuelled by rising expectations, technological advances which are often costly, medical breakthroughs and other factors

(2)  Resourcing  (financial and other)  the demands of an ageing population who consume more resources, with the added factor of a relative decrease  in economically productive young wage earners

(3)  Evolving a society devoid of intergenerational disputes and replete with respect and love - a cohesive, equitable and productive society, with the wisdom and maturity of old age, balancing the exuberance of youth. Today’s young are tomorrow’s old; all have a stake. 

These challenges could be met by adopting various measures such as, 

(1)  A major shift in attitudes and perceptions of what it means to progress through life from birth to death, getting rid of the negative image of old age, utilisation of a range of skills and talents of old people set free from the need to pursue active employment, greater involvement in voluntary work, providing support for children and grandchildren.  

(2) When the retirement age was set years ago, the expectation was that retired people would live on average about 5 years more before they die according to life expectations at the time. This has changed over the years and at present, retired people can expect to live at least a further 10 years or more. This has major funding implications and current pension arrangements are not sustainable and the concept of retirement needs to be reviewed. The Shakespearean concept of 3 score years and 10 is outmoded and a good model is one of the 3 ages, the first is one of growing up and learning, the second is one of adulthood with employment, marriage and parenthood and the third age is one of gradual withdrawal from active employment with pursuit of leisure. These are blend into each other. 

(3)  Forward planning to meet the demands of a large increase in the number of old people.  

(4)  Change emphasis from a Disease Model to a Preventive model. The aim is to ensure that longevity is matched by a long disability-free period and not by the nightmare scenario of prolonging life by extending the period of disabled life that often precedes death, using the old adage, “add life to years and not years to life”.

 (5)  Towards this end, the message is that living a healthy life when you are young has to be promoted to achieve a healthy old age.

Among the suggested measures are:- 

•  control of hypertension,

•  attention to a proper diet, weight control

•  regular mental and physical exercise

•   correction of lipid abnormalities

•   smoking cessation

•   correction of abnormalities of heart rhythm, such as atrial fibrillation

•  Social interventions, such as libraries, heating allowances, and free health checks, need funding but will produce long-term savings and benefits.

•  Imaginative housing and home care schemes

•  Incentives such as low-cost or free recreational facilities and transport for older people  

(6) Creative use of new technologies, e.g., telemedicine, smart homes, and house robots.  

(7) Suitable national and international legislation to protect older people. 

(8) It is also suggested that we need to rethink our attitude to death and prolongation of life. The largest proportion of the total healthcare budget spent per person is at the end of life.

Death is as inevitable as life and without death, life cannot be sustained. Death is not a failure; accept death with dignity and equanimity.  

In conclusion,  

We must change how we think about our lives and progress from birth to death.

We have to re-engineer the concept of retirement

We need to devote more resources towards dementia research

We need to fight against ageism and paternalism. We must escape from the concept of A World for the Young to a World for All.

We need to harness the immense potential of technology and remain optimistic.

Addendum on 6th April 2024

As ageing was regarded as a “natural” process, not much energy was devoted to its underlying mechanisms. In other words, nobody seriously considered altering the ageing process through manipulative processes.

With the outlook for longevity improving, curiosity about the ageing process itself was aroused. Why do animals age? What are the genetic and environmental causes? Is it possible to slow down or even abolish the ageing process? Will a change in the rate of ageing reduce age associated disease?

Studies into the ageing process have made big advances recently. The genetics of ageing, the role of stem cells, the role of inflammation, and changes in fat metabolism are just a few. We are yet to see implementable strategies to change the ageing process in Humans although there are some promising animal experiments.

Of those still alive in our batch, we are all over the age of 75. The time when many of the actions we could have (and should have taken) is sadly now gone. BUT…

It is never too late to institute lifestyle changes and take therapeutic measures if indicated.

Wishing to slow the ageing process is not mainly about living longer but about living healthier and happier for longer. (as shown in the famous Fries Compression of morbidity graph above)

Ask the Expert:- MANOBHAWAYE ABADHA- MOOD DISORDERS - BY DOUGLAS MULGIRIGAMA

The launch of MANASIKA SAUKYAYA 2 - MANOBHAWAYE ABADHA

The second book by Dr Douglas Mulgirigama, Retd Consultant Psychiatrist

Douglas Mulgirigama published his second book on the 5th of June 2023. The launch of the first book was reported in our Blog on the 17^th of December 2019. Here is the link: Please click on it to open the post and the 39 comments on it:

https://colombomedgrads1962.blogspot.com/2021/12/douglas-mulgirigama-first-book.html#comment-form

The launch of his first book, titled ‘මානසික පීඩනය සහ කාංසාව (“Mental Stress and Anxiety”), was on the 19th of January 2019 at BMICH. The Chairperson was Professor Ven Kotapitiye Rahula. By good fortune, it was at the time of the 150th-anniversary celebrations of the Medical College and a few of our Batch mates were able to attend. Those who attended included: Pramilla Senanayake, Bandula Jayasekera, Lucky Abeyagunewardene, Indra Anandasabapathy, Dharmani and Amara Markalanda.

At the launch, Douglas said “I am very proud to be a Sri Lankan and from my young days took great interest in studying the history of Sri Lanka, Sinhala Language and Buddhism. Probably my close contact with the local temple and the monks were influential in this. I also became interested in studying medicine. It was a Buddhist monk in the temple who germinated the seed describing it as a Noble Profession and the enormous merit one could gain by helping others and healing the sick”.

About his second book, Douglas says, “My second book is titled, ‘Mood Disorders - Depression and Mania’ which I wrote in Sinhala same as my first book entitled ‘Mental Stress and Anxiety’. Last month I have been in Sri Lanka running round and preoccupied with getting the book published. Sarasavi Publishers did an excellent job, and the book was launched at the Sarasavi Book Shop, at Nugegoda on Monday the 5th of June 2023. Pramila very kindly attended the occasion representing my whole batch. I am very thankful to her. Attaching few photos of the occasion. Mr H. D. Premasiri (Owner and Director of Sarasavi Publishers) presenting the book to me, and me presenting the book, among others to Pramila.  Very happy to be able to continue this project which I am hoping to write on mental Health topics as a series in Sinhala”

What he stated at the first book launch, “I have two aims: to make accurate and up-to-date information on Mental Health available to the public and making at least a modest attempt to reduce the stigma attached to Mental illness”, still applies.

The book is available online for LKR 1080 (plus postage) from:-

https://www.sarasavi.lk/manasika-saukyaya-2---manobhawaye-abadha-9553128270

On behalf of all the ColomboMedgrads1962, I salute you with great pride and admiration.

Mahendra “Speedy”  Gonsalkorale

Ask the Expert .. Chirasri Jayaweera Bandara on Cataracts

ASK THE EXPERT........

A New Series on our Blog. I shall request colleagues to enlighten us on topics of great interest to us as we are all well into the stage where these topics have become more relevant to us. I shall add some relevant prior posts to this category.

The first is on cataracts and cataract surgery by our Batch expert Chirasri Jayaweera Bandara,  retired Consultant Eye Surgeon who very kindly responded to my request.

CATARACT  SURGERY - Dr Chirasri Jayaweera Bandara

TYPES OF CATARACTS: 

1.Senile       2.Congenital

3.Traumatic                     4.Metabolic            5.Druginduced

a.Contusion                     a.Diabetes                   a. Corticosteroids

b.Penetrating injury         b. Galactosemia                  oral & topical

c.Radiation         c.Hypocalcaemia      b.Phenothiazines

d.Electrical injuries

e.Chemical injuries         d. Wilson’s disease       c. Miotics

                                       e. Myotonic Dystrophy  d. Amiadarone

                                                                             e. Statins

                                                                             f. Tamoxifen                                

 VARIETIES OF CATARACTS     

1. Cortical -  Lens opacities in the periphery

2. Nuclear -  Lens opacities in the nucleus

3. Posterior Sub Capsular (PSC) Lens Opacity – Starts as a small lens opacity at the back of the lens right in the path of light

·      Early decrease in vision is noted by patients in the 2^nd and 3^rd  varieties of 

      cataracts mentioned above.

·      This is felt mostly when exposed to the sun as pupils get constricted and block the light through the periphery of the lens. Wearing dark glasses will help initially at this stage.

·      Treatment for cataracts is only surgery when vision is compromised.

·      Surgery is done when patients find it difficult to carry out their daily routine satisfactorily.

SURGERY

Historically done under general anaesthesia or retrobulbar Lignocaine injection. 

At present, it is usually with topical anaesthesia ( Lignocaine ) and occasionally with subtenon Lignocaine injection.

 

IN THE PAST

IntraCapsular Cataract Extraction (ICCE)

The whole cataract was extracted after pupillary dilatation and after making the incision at the superior half of the limbus. (corneoscleral junction).

This was done with the Erysophake or Intracapsular forceps or the Cryoprobe. 

Next,  ExtraCapsular Cataract Extraction (ECCE)

After pupillary dilatation, an incision is made at the superior half of the limbus, then a Capsulotomy is done where the anterior capsule is cut in a circular manner with a bent tip of a 26 G needle. The circular piece of the anterior capsule was removed, leaving an annular anterior capsule and the whole of the posterior capsule intact. 

Once the cataract is removed the vision will only be 1/60   (i.e. only one meter

distance will be visible).

In the past after cataract extraction patients were given very thick glasses.

+10  to +12 Diopter power glasses (“ bothal adi “ glasses ) as IOLs were not available. 

 INTRA  OCULAR  LENSES  (IOL)            

Biometry is done prior to the surgery to calculate the IOL power to suit the patient's eye measurements.

PMMA  PolyMethylMethAcrylate  IOL is inserted through the large limbal incision after extracapsular cataract extraction. Because of the relative rigidity of these lenses, a large incision was required.

CURRENTLY

PHACOEMULSIFICATION  CATARACT  SURGERY 

Preoperatively,

·       Best corrected vision is noted.

·       Cataract assessment is done at the slit lamp.

·       The eyelids for blepharitis, clarity of the cornea, type of cataract and the viability of the capsular bag and the zonules which hold it in place are examined.

·         Intra Ocular Pressure ( IOP) is checked.

·        Pupils are dilated and the retina is checked to assess visual prognosis.

·       Fasting blood sugar, ECG along with a general systemic examination is done.

·       Antiplatelets and anticoagulants are omitted with cardiology guidance, but this is not compulsory as the incision could be made at a bloodless area through the cornea.

·       IOL  power is calculated with biometry.

·       The pupil is dilated fully.                                                           

Intraoperatively,

·       Topical Anaesthesia Lignocaine is instilled along with dilute betadine solution prior to commencing the surgery.

·       Sterile drape applied.

·       Speculum placed to keep the lids opened and eyelashes out of the field of surgery.  

·       Done under an operating microscope with the patient lying supine.

·       Surgeon sits at the head end of the operating table or on the (temporal) side of the head.

·       Incision 2.2 mm made with a Keratome at the limbus. (main port)

·       Combined solution with anaesthetic and dilating agent is introduced into the anterior chamber.

·       Methylene blue is injected into the anterior chamber to stain the anterior capsule of the      cataract.

·       26 G Needle tip is bent in preparation of capsulotomy.

·       Methylene blue (injected earlier) is washed off with balanced salt solution (BSS) .

·       Viscoelastic material is introduced into the anterior chamber to maintain intraocular space for the next steps of the surgery.

·       Capsulotomy is done in a circular curvilinear manner central to the dilated pupil with the bent tip of a 26 G  needle or with a Capsulorrhexis forceps.

·       Circular piece of the anterior capsule is removed.

·       Hydrodissection is done by injecting Balanced Salt Solution (BSS) under the remaining capsule to separate the nucleus from the capsule.

·       Two side ports 1.1 mm are made opposite to each other, generally around 90 degrees from the main port (according to the surgeon’s preference).

·       The Phacoprobe is introduced through the main port into the anterior chamber.

 

                     PHOTO 1  PHACOPROBE

Note at the bottom (diagram)                         The Ultrasound power line is attached to the centre of the probe, the irrigation and aspiration lines alongside. Also note above (diagram)        The irrigation port near the tip and  aspiration port at the tip.

                                           

·        A groove is made in the cataract with the Phacoprobe as shown below.

                             

PHOTO 2  GROOVING

·       The nucleus is rotated and another grove is made at right angled to the former.

·       The nucleus is first cracked into 2 as shown below.

PHOTO 3  NUCLEUS OF THE CATARACT CRACKED INTO 2    

·       The halves are then cracked further resulting in 4 quadrants.

·        Finally it is emulsified and aspirated.

·       Then the remaining cortical lens matter is aspirated and a clean capsular bag with an annular peripheral ring of the anterior capsule and the whole intact posterior capsule is left for IOL insertion.

·       Foldable Acrylic IOL is introduced through the main port. The IOL

      unfolds itself into the capsular bag.

·       Premium IOLs – Multifocal/astigmatic IOL s are also available on request.

·       The incisions are sealed by hydrating with BSS which will cause a small localized opacity lasting only a few minutes

PHOTO  4   FOLDABLE  ACRYLIC  I.O.L.

POST  OP 

·       Antibiotics, Steroids and Non Steroidal Anti Inflammatory Drugs (NSAID)

      eye drops are prescribed, with a tailing off dose spanning a month or so

(if uncomplicated)

·       Surgery could be done as a day surgery (in the Private sector in Sri Lanka)

·       In the Government Hospitals in Sri Lanka, the patients are routinely admitted the previous day and they may be discharged the next day.

·       Glasses are prescribed for near work (presbyopic glasses).

·       Patients who get Multifocal IOL inserted at the time of surgery, could do near work without the need for presbyopic glasses. 

Surgery was done by my daughter Anjali Jayaweera Bandara Senior Registrar, Eye Hospital Colombo.

I am thankful to Anjali for recording her surgery and producing the video with captions.

Note from Speedy...

What follows is a video of a cataract surgery performed by Chira's daughter Anjali Jayaweera Bandara Senior Registrar, Eye Hospital Colombo.

Please read the steps of the surgery given above before watching the video of cataract surgery. 

Please click on the image to commence the video.

To see the video in FULL SCREEN, when the video starts, please click the icon at the bottom right (as in any YouTube Video). The icon will appear ONLY when you start the video.

 ASK THE EXPERT.........Questions on  Cataract Surgery (sent by Mahendra )

 

1.  Q.  Will all who develop cataracts need an operation if they live long enough?

    A. Not if the vision is good and you are managing your daily routine satisfactorily. 

2.  Q.  How important is the timing of when to remove?

A.  When you cannot manage your daily routine and feel you need better vision. 

3.  Q.  Will a delay in an operation lead to a poorer outcome?

     A.   When the cataract becomes hypermature, the proteins leak out through the   

    capsule, causing a reaction in the anterior chamber, increasing the intraocular pressure which results in a painful red eye. This is called Phacolytic Glaucoma.

    Then the patient is initially treated to reduce the eye pressure and inflammation preoperatively. In some cases, vision may not be very good.    

4.  Q.    Is it common for senile macular degeneration to coexist with cataracts?

     A.  No, it generally has a different pathology and is not as common as senile cataracts 

5.  Q.  What are the indications for operation?

     A.  Poor vision, when the patient cannot manage the daily routine.

          When glaucoma is secondary to cataract

          A breach in the lens capsule (in case of traumatic cataracts)      

6. Q.  Can both eyes be done at the same time?

     A.  Not routinely, because of the rare complication of infection. 

7.  Q.  If not how far apart should they be if both need doing?

      A.  Generally, after 3 months but it could be done before if indicated. 

8. Q.  How safe is it?

     A. Safe in good hands. 

9. Q.  Are there recognised complications?

     A.   Posterior capsular rupture (PCR) during surgery.

            Rare complication of lens drop into the vitreous after PCR.

            All these could be managed successfully.

           Rare complication of infection.   

10. Q.  How long does a cataract extraction take to perform from the time of entry to the theatre to leaving?

       A.    Between 20 to 25 minutes. ( the surgery itself 15 to 20 minutes.) 

11.  Q.  Is it always a day operation?

        A.  It is day surgery in the private sector in Sri Lanka but in the Government

sector patients are admitted the previous day and maybe discharged the following day. 

12.   Q.  Am I conscious during the operation?

         A. Yes, surgery is done under topical anaesthesia or occasionally local nerve blocks.

          Not done under GA unless exceptional cases or opted for. 

13.   Q. How do I keep my eye still during the operation?

         A. The patient is simply asked to look straight and it is aided by instruments by the surgeon. 

14.    Q.  How much aftercare is required after the operation?

          A. Not much but to instil antibiotic and steroid eye drops and to wear an eye shield for physical protection. 

15.    Q. How soon can I drive a car again?

         A.  In a couple of days depending on the vision in the other eye. 

16.     Q. What types of lenses are used to replace the affected lens?

         A. Foldable Intraocular lenses made of Acrylic material are inserted during Phaco surgery.

PMMA (PolyMethylMethaAcrylate) material IOLs are inserted in Extra Capsular Cataract Extraction. PMMA IOLs are rigid could be inserted after phaco surgery too after enlarging the incision. (If foldable IOLs are not available.)

     Multifocal IOL are also inserted on request by the patient, where spectacles are not required for close work. 

17.   Q. What can a person expect as an outcome and when will the benefits be seen?

            A. Excellent outcome and benefits will be seen immediately intraoperatively provided the rest of the eye is normal. 

18.    Q.  Can any Ophthalmologist do it or are there those who have specialised?

          A.  Any Consultant Ophthalmologist, Senior Registrar and trained Registrar

           can do the surgery.     

If readers have suggestions for the next Ask the Expert, please email me.

Speedy

Ask the Expert:- Free education and freedom for Free Medical education in Sri Lanka

Free education and freedom for Free Medical education in Sri Lanka

Prof S P Lamabadusuriya.  IMPA Journal, Volume 14, No 1. December 2020

Note from Speedy: This important article by Sanath published by the Independent Medical Practitioners Association Journal Sri Lanka was sent to me by Sanath with the following request. 

"Herewith I have attached an article titled "Free Education and Freedom for Private Medical Education in Sri Lanka", which was published in the IMPA Journal and a PowerPoint presentation I delivered at the OPA sometime back. It is a controversial topic in Sri Lanka at present, with the SL Government trying to pass a bill in parliament about expanding the KDU so as to accommodate fee-levying students for medicine, which has generated street protests.  Please post both versions on our blog spot on my behalf". 

I managed to trace the article on the Web and get a proper download. This is the first part.  The second is a PowerPoint presentation which will follow. The article will be of great interest to us and I am grateful to Sanath for sending it to me.  Incidentally, I noted that our own SAP Gnanissara is on the Editorial Board of the IMPA.